Healthcare Provider Details

I. General information

NPI: 1649297797
Provider Name (Legal Business Name): WILLIAM C GEHRHARDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 PULASKI RD
GREENLAWN NY
11740-1602
US

IV. Provider business mailing address

284 PULASKI RD
GREENLAWN NY
11740-1602
US

V. Phone/Fax

Practice location:
  • Phone: 631-425-5250
  • Fax: 631-425-0140
Mailing address:
  • Phone: 631-425-5250
  • Fax: 631-425-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224722
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: